Throughout Jean A. Bilows time at the Jefferson County Public Health Service, she has seen both the agency and the health-care industry evolve to focus on prevention and keeping people healthy.

Now, after dedicating most of her life to health care and the past 38 years to the agency, she will retire as the agencys executive director Feb. 28.

When I look back in public health, much has been accomplished, and much still needs to be accomplished, she said.

Ms. Bilow began her career as a public health nurse in 1975, when the agency was known as Jefferson County Public Health Nursing Services. In the 1970s, she said, programs were nurse-centered.

Although Ms. Bilow said she intended to use her nursing degree and masters degree in community health and health education to become a school nurse, she quickly found the public health nurse job to be a perfect fit.

By 1976 she was promoted to assistant supervising public health nurse, and then supervising public health nurse in 1979.

The more involved she became with managing Jefferson Countys public health agency, the more she was entrusted with leading it. Ms. Bilow held other titles such as interim director of patient services and director of patient services before being appointed director of public health in 1987.

There was such growth in programs in the 1980s that to have a director of patient services and the administration became a large workload, Ms. Bilow said.

After the state required public health agencies to conduct community health assessments in order to receive public health state aid in 1986, the state also required each county public health agency to have a full-time director of public health.

Some of the biggest changes Ive seen would be the expansion of home health care, Ms. Bilow said. Its become very important, particularly for local departments, because as populations have aged, individuals have more chronic diseases. Hospitals also discharge patients earlier than prior years.

She said home health care represents about 70 percent of the departments workload.

While there has been a large focus on preventive efforts in the past few years, Ms. Bilow said that push really began in the early 1990s when anti-tobacco efforts became a public health priority. Jefferson County Public Health Nursing Services then created what Ms. Bilow calls a health promotion unit, where nutrition, physical activity, work site wellness and other programs were promoted.

As that unit formed, so did the opportunity for grants to support the growth in services.

Health promotion continues today, although theres not the same number of dollars and grants available, she said. It does make a difference to the citizens of Jefferson County.

As the department progressed, its name changed to Jefferson County Public Health Service because programs no longer were specific to nursing. Jefferson County residents were becoming educated on health, and in the 2000s, county health plans were developed.

With all of the changes throughout the past few decades, the budget has gone from $633,000 in 1981 to $8.3 million in 2013. In the late 1980s, there were 41 direct and contractual employees, and now there are about 200. Clinic visits also jumped from 3,700 in 1981 to a projected 6,500 for 2013.